Causes of Cirrhosis
Basic facts about the liver
Your liver, the largest organ in your body, weighs about three pounds
and is roughly the size of a football. It lies in the upper right
side of your abdomen situated mostly under the lower ribs. The normal
liver is soft and smooth and is connected to the small intestine
by the bile duct which carries bile formed in the liver to the intestines.
Nearly all of the blood that leaves the stomach and intestines must
pass through the liver. Acting as the body's largest chemical factory,
it has thousands of functions including:
the production of clotting factors, blood proteins, bile
and more than a thousand different enzymes
the metabolism of cholesterol
the storage of energy (glycogen) to fuel muscles
maintenance of normal blood sugar concentration
the regulation of several hormones
and the detoxification of drugs and poisons including alcohol.
It is no wonder that liver disease can cause widespread disruption
of body function. While many liver diseases can occur, one of the
most important is cirrhosis.
What is cirrhosis?
Cirrhosis is a term that refers to a group of chronic liver diseases
in which normal liver cells are damaged and replaced by scar tissue,
decreasing the amount of normal liver tissue. The distortion of
the normal liver structure by the scar tissue interferes with the
flow of blood through the liver. It also handicaps the function
of the liver which, with the loss of normal liver tissue, leads
to failure of the liver to perform some of its critically important
functions. Cirrhosis and other liver diseases take the lives of
over 25,000 Americans each year and rank eighth as a cause of death.
What causes cirrhosis?
There are a number of conditions that can lead to cirrhosis:
excessive intake of alcohol (most common)
types B, C and D of chronic viral hepatitis,
inherited or congenital diseases --
hemochromatosis -- abnormal accumulation of iron in the liver and
other organs because of the increased absorption of iron from the
Wilson's disease--abnormal accumulation of copper in the liver
and other organs due to the decreased excretion of copper from the
alpha1-antitrypsin deficiency--inherited absence of a specific
enzyme in the liver.
glycogen storage diseases --inability to properly utilize sugars.
prolonged obstruction or other diseases of the bile ducts
(biliary cirrhosis, sclerosing cholangitis)
prolonged exposure to environmental toxins
some forms of heart disease (cardiac cirrhosis)
severe reaction to drugs
schistosomiasis (parasitic infection)
Can the condition responsible for cirrhosis be identified?
Causes of the cirrhosis can be identified by certain factors:
In alcoholic cirrhosis
history of regular and excessive alcoholic intake physical
and behavioral changes
examination of liver tissue obtained by needle biopsy under
In active viral hepatitis infection
Does heavy drinking always lead to cirrhosis?
While almost everyone who drinks excessive amounts of alcohol sustains
some liver damage, it does not necessarily develop into cirrhosis.
In those individuals who drink one-half to one pint (8 to 16 ounces)
of hard liquor per day (or the equivalent in other alcoholic drinks),
for 15 years or more, about one-third develop cirrhosis. Another
third develop fatty livers, while the remainder have only minor
liver problems. In general, the more you drink, the greater the
frequency and regularity of excessive intake, the more likely that
cirrhosis is to result. A poor diet, long considered to be the main
factor in the development of cirrhosis in the alcoholic, is probably
only a contributing factor. Alcohol by itself, in large amounts,
is a poison which can cause cirrhosis.
Can social drinkers get cirrhosis?
Some individuals who are "social drinkers," not alcoholics, can
develop cirrhosis. Factors affecting the development of cirrhosis
the amount of alcohol consumed
the regularity of intake
perhaps the state of nutrition
It is not known why some individuals are more prone to adverse
reactions to alcohol than others. Women are less tolerant of alcohol
than men. Researchers believe that this is because men have a greater
ability than women to break down the alcohol for elimination. Studies
show that a much higher percentage of women, consuming less alcohol
than men, go on to cirrhosis.
Does hepatitis always result in cirrhosis?
Some patients with chronic viral hepatitis develop cirrhosis. There
are five known types of viral hepatitis, each caused by a different
Acute Hepatitis A and acute Hepatitis E do not lead to chronic
Acute Hepatitis B leads to chronic infection in approximately
5% of adult patients.
In a few of these patients, the chronic Hepatitis B progresses to
Acute Hepatitis D infects individuals already infected by
Acute Hepatitis C becomes chronic in approximately 80% of
adults. A minority of these patients (20-30%) will progress to cirrhosis,
typically over many years.
What are the signs and symptoms of cirrhosis?
The onset of cirrhosis is often "silent" with few specific symptoms
to identify what is happening in the liver. As continued scarring
and destruction occur, the following signs and symptoms may appear:
Loss of appetite
Nausea and vomiting
Enlargement of the liver
Jaundice--yellow discoloration of the whites of the eyes
and skin occurs because bile pigment can no longer be removed by
Itching--due to the retention of bile products in the skin
Ascites--abdominal swelling due to an accumulation of fluid
caused by the obstruction of blood flow through the liver
Vomiting of blood--frequently occurs from swollen, ruptured
varices (veins that burst) in the lower end of the esophagus due
to the increased pressure in these vessels caused by scar tissue
Increased sensitivity to drugs--due to inability of the liver
to inactivate them
Encephalopathy (impending coma)--subtle mental changes advancing
to profound confusion and coma.
Many patients may have no symptoms and are found to have cirrhosis
by physical examination and laboratory tests, which may have been
performed in the course of treatment for unrelated illnesses.
How is cirrhosis treated?
Treatment depends on the type and stage of the cirrhosis. It aims
at stopping the progress of the cirrhosis, reversing (to whatever
extent possible) the damage which has already occurred, and treating
complications that are disabling or life-threatening. Stopping or
reversing the process requires removal of the cause.
In alcoholic cirrhosis
abstinence from alcohol
an adequate, wholesome diet
In cirrhosis caused by viral hepatitis
an approved approach is the use of interferon to improve
immune responses to viral infection.
Experts estimate that more than half of all liver diseases could
be prevented if people acted upon the knowledge we already have.
Each year more than 25 million Americans are afflicted with liver
and gallbladder diseases and more than 25,000 die of chronic liver
disease and cirrhosis. There are few effective treatments for most
life-threatening liver diseases, except for liver transplants. Meanwhile,
patients and their families must cope with medical, financial and
Research has recently opened up exciting new paths for investigation,
but much more remains to be done to find cures for more than 100
different liver diseases and help millions of Americans who are
suffering. To increase the number of liver researchers, the American
Liver Foundation encourages young scientific investigators to pursue
careers in liver research by supporting bright, highly trained men
and women in their quest for answers. Research and education have
made a difference. When the Foundation first became operational
in 1979, reported deaths due to chronic liver diseases and cirrhosis
exceeded 50,000 each year. By 1992, that figure was reduced to 26,000.
Concerned contributors like you have enabled us to increase Foundation-supported
research tenfold since 1980.
In the past year the Foundation has counselled, encouraged, and
informed over 35,000 anxious victims of liver disease. We distributed
two million brochures to patients and referred hundreds to medical
specialists. We thank you for your thoughtful support and confidence
in our efforts. You have enabled us to touch the lives of millions
of Americans who look to the American Liver Foundation for guidance,
support and encouragement.
In certain types of cirrhosis caused by autoimmune hepatitis
corticosteroids alone or with azathioprine may be an effective
In cirrhotic patients with jaundice
supplemental fat soluble vitamins may be helpful
removal of excessive copper by drugs that deplete the body's
removal of excess iron by phlebotomy (removal of one pint
of blood per week)
Most types of cirrhosis
liver transplantation with replacement of the diseased organ
when advanced liver failure occurs
What are the complications of cirrhosis?
Complications of cirrhosis include ascites, coma and hemorrhage
from esophageal varices.
Ascites is treated by reducing the intake of salt and the
administration of drugs to improve excretion of salt and water (diuretics).
In some instances, large amounts of fluid are removed by direct
catheter drainage through the abdominal wall (large volume paracentesis).
Treatment of coma, or impending coma (encephalopathy), includes
specific medications, reducing the intake of protein foods, and
control of intestinal hemorrhage.
Treatment of hemorrhage from varices (internal varicose veins)
includes sclerotherapy (injection of the enlarged vein with a chemical
that causes scarring). Other treatments include: drugs to reduce
the likelihood of bleeding or rebleeding, compression of the bleeding
varices with a specially constructed balloon, and a new radiological
procedure called transjugular intrahepatic portosystemic shunt (TIPS).
How can I avoid cirrhosis?
1.Do not drink to excess. Avoid the use of alcoholic beverages.
Alcohol destroys liver cells. How well damaged cells regenerate
varies with each individual. Prior injury to the liver by unknown
and unrecognized viruses or chemicals can also affect the regeneration
2.Take precautions when using man-made chemicals. The liver must
process many chemicals which were not present in the past. More
research is needed to determine the effects on the liver of many
of these compounds. When using chemicals at work, in cleaning your
home or working in your garden:
be sure there is good ventilation
follow directions for use of all products
never mix chemical products
avoid getting chemicals on the skin, where they can be absorbed,
and wash promptly
if you do
avoid inhaling chemicals
wear protective clothing
3.Seek medical advice. Remain under supervision of a physician
if you develop viral hepatitis until your recovery is assured.
How might cirrhosis affect other diseases I might have or treatment
The responsibility of the liver for the proper functioning of the
whole body is so great that the chronic disease of the liver may
modify the body's responses to a variety of illnesses. Abnormal
function of the liver in cirrhosis may:
affect the dose of medicine required in the treatment of
affect the treatment of diabetes
alter response of the body to infection
alter tolerance for surgical procedures
Patients with cirrhosis are particularly prone to develop fatal
bacterial infections, kidney malfunctions, stomach ulcers, gallstones,
a type of diabetes and cancer of the liver.
What are my prospects for reasonable health and survival with
Treatment at this stage, with proper adherence to the physician's
recommendations, leads to improvement in the majority of cases and
the patient is able to pursue a normal life and activities.
When cirrhosis is not discovered until extensive damage has resulted,
the outlook may be less favorable for improvement, and complications
such as ascites and hemorrhage are more likely to be encountered.
The liver is a large organ and is able to perform its vital functions
despite some damage. It also has the ability to repair itself to
a limited degree. Cells that die are replaced by new cells. If the
cause of cirrhosis can be removed, these factors provide hope for
both improvement and carrying on a normal life.
An increasing number of scientific investigators conducting liver
research give hope for new breakthroughs in treatment, management
and cures for liver diseases in the foreseeable future.
Copyright © 1997 The American Liver Foundation